| NPI | 1366501108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR N-7372) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AR N-7372) |
| 208D00000X General Practice (Licence: OK 1805) | |
| Enumeration Date | 2006-12-07 |
| Last Update Date | 2019-12-05 |